Massive volume loss, severe adhesions/tethering, uneven contour, lack of lift - how can this be improved? (Photos)

Question

Hi everyone and Doctors on RealSelf, I am currently 1 year post-op from a SMAS facelift, and I am extremely distressed with my results and looking for guidance or revision options. Unfortunately, my primary surgeon was very aggressive and lacked the delicate technique needed for this procedure. I have noticed severe issues in the dissected areas: 1. Massive Fat & Volume Loss: The fat layer in the dissected zone seems to have largely dissipated, leaving my face looking hollow and aged rather than refreshed. 2. Adhesions & Tethering: Specifically around my cheekbones and the corners of my eyes, the skin feels heavily stuck down to the underlying tissue with tight. 3. Uneven & Pitted Contour: My skin texture is now dented, bumpy, and visibly irregular 4. No Visible Lift: Despite going through this major surgery, there is virtually no structural lift to my mid-face or lower face. I believe the hollowing in my face after the facelift happened because the surgeon attempted to lift my cheek fat pads (malar fat pads), but the procedure was performed too aggressively, causing the entire cheek fat pad to lose its blood supply and die. desperately need help！do I need to do the restore together with the revision facelift or I can do it separately? Like restore mid face hollow first and second lift? I am reaching out to see if anyone has dealt with a similar situation or if any facial plastic surgeons specializing in revision facelifts could share their insights. Any advice, doctor recommendations, or similar experiences shared would be deeply appreciated. Thank you so much!

Elie Ramly, MD · Answer

Thank you for your questions and for sharing your experience. I understand why these changes would be concerning. At one year after a SMAS facelift, the tissues are generally mature enough that an evaluation for possible revision or secondary facelift surgery is reasonable.
Your photographs appear to show areas of facial volume deficiency, contour irregularity, and possible scar tethering or adhesions, particularly through portions of the cheek and midface. However, photographs alone cannot determine exactly what occurred during the original facelift, and I would be cautious about concluding that the malar fat pad lost its blood supply or “died.” Other variables at play could include irregularity in the subcutaneous fat layer, postoperative scar tissue and adhesions, uneven tissue positioning or pulling, and skin tethering.
The key in revision facelift surgery is to accurately identify each anatomical problem and address those systematically to restore healthy anatomical relationships, structural proportions, and aesthetic harmony. Depending on your examination and previous surgery, treatment may involve formal revision facelift surgery to improve tissue position and vectoring, careful release of tethered scar tissue or adhesions, and structural facial fat grafting to restore lost volume and smooth contour irregularities.
Regarding your question about timing, fat grafting and revision facelift surgery can often be performed together. This can allow the surgeon to address both facial tissue position and volume deficiency during the same operation. In other cases - particularly when there is significant scar tissue, uncertainty regarding the underlying anatomy, or a need to assess the response to volume restoration - a staged approach may be preferable.
Revision facelifts are different from primary facelifts because the surgeon must account for previously dissected tissue planes, scar tissue, adhesions, altered anatomy, remaining facial volume, skin quality, and what was performed during the first operation. For that reason, I would obtain your original operative report if possible and seek an in-person consultation with a plastic surgeon who has significant experience with complex secondary and revision facelift surgery and facial fat grafting.
A careful in-person examination should help determine what is contributing to the tethering, subcutaneous contour irregularities, and volume loss, and whether fat grafting alone, scar release, revision facelift surgery, or a combined approach offers the most appropriate path toward restoring smoother, more natural facial contours.

Massive volume loss, severe adhesions/tethering, uneven contour, lack of lift - how can this be improved? (Photos)

Answers (1)

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